Compartments of the antebrachial fascia of the forearm: clinically relevant ultrasound, anatomical and histological findings

Ortiz-Miguel, Sara; Miguel-Pérez, Maribel; Navarro, Joana; Möller, Ingrid; Pérez‐Bellmunt, Albert; Agulló, José Luis Rodríguez; Ortiz-Sagristà, J.C.; Blasi, Juan; Martinoli, Carlo

doi:10.1007/s00276-021-02736-3

Cited by 6 publications

(10 citation statements)

References 25 publications

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“…Moreover, the importance of the deep/muscular fascia thickness in the acute and chronic compartment syndrome suggests the use of US imaging to evaluate fascial thickness in the case of these pathologies as an inexpensive, safe, non-invasive, portable, and most of all, effective tool [2]. This is the first work to our knowledge to examine and compare the thicknesses of the deep fascial layers of the arm and forearm using US imaging.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, knowing the exact thickness of a patient's fasciae reduces the risk of nerve damage during a peripheral block procedure and it makes it possible to predict the effect of compartment models of anesthetic drugs [1]. Several studies have also confirmed the importance of the deep/muscular fascia thickness in the acute compartment syndrome [2]. The latter is defined as a limb-threatening and occasionally life-threatening condition caused by bleeding or edema in a close muscle compartment surrounded by fascia or bone [3].…”

Section: Introductionmentioning

confidence: 99%

“…While this knowledge is present for the thoracolumbar fascia and the fasciae of the inferior limbs, to date, no study has evaluated the fascial thicknesses of the brachial and antebrachial fasciae measured by ultrasound imaging in the different points. For the antebrachial fascia, it is only known that high-definition US imaging allows its identification in relationships with the adjacent structures [2,14,15]. Furthermore, it is well known from dissection that in the upper limb, the deep fasciae have aponeurotic features, being a strong, almost white laminar sheet of connective tissue that covers the muscles.…”

Section: Introductionmentioning

confidence: 99%

“…The body areas at risk of developing compartment syndrome are the limbs, and the most affected compartments are the anterior compartments in the leg and the forearm, due to their high fascial rigidity [ 3 ]. In both, the main treatment is fasciotomy [ 2 ]. So, in recent years numerous investigations have been carried out on this topic to understand the anatomical features of the various fasciae of the body [ 2 , 4 ], both in cadavers and in live individuals using Ultrasound (US) Imaging [ 5 , 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…In both, the main treatment is fasciotomy [ 2 ]. So, in recent years numerous investigations have been carried out on this topic to understand the anatomical features of the various fasciae of the body [ 2 , 4 ], both in cadavers and in live individuals using Ultrasound (US) Imaging [ 5 , 6 , 7 , 8 ]. The latter, thanks to its high definition, the possibility to visualize the musculo–skeletal structures in a dynamic way and the lower cost when compared to other non-invasive methods [ 8 , 9 , 10 ], it has become an important tool for studying fascial anatomy and pathology in a rehabilitative point of view [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound Imaging of Brachial and Antebrachial Fasciae

et al. 2021

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Knowledge about fasciae has become increasingly relevant in connection to regional anesthesiology, given the growing interest in fascial plane, interfascial, and nerve blocks. Ultrasound (US) imaging, thanks to high definition, provides the possibility to visualize and measure their thickness. The purpose of this study was to measure and compare, by US imaging, the thickness of deep/muscular fasciae in different points of the arm and forearm. An observational study has been performed using US imaging to measure brachial and antebrachial fasciae thickness at anterior and posterior regions, respectively, of the arm and forearm at different levels with a new protocol in a sample of 25 healthy volunteers. Results of fascial thickness revealed statistically significant differences (p < 0.0001) in the brachial fascia between the anterior and the posterior regions; in terms of the antebrachial fascia, no statistically significant difference was present (p > 0.05) between the regions/levels. Moreover, regarding the posterior region/levels, the brachial fascia had a greater thickness (mean 0.81 ± 0.20 mm) than the antebrachial fascia (mean 0.71 ± 0.20 mm); regarding the anterior region/levels, the antebrachial fascia was thicker (mean 0.70 ± 0.2 mm) than the brachial fascia (mean 0.61 ± 0.11 mm). In addition, the intra-rater reliability reported good reliability (ICC2,k: 0.88). US imaging helps to improve grading of fascial dysfunction or disease by revealing subclinical lesions, clinically invisible fascial changes, and one of the US parameters to reliably evaluate is the thickness in the different regions and levels.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ultrasound Imaging of Brachial and Antebrachial Fasciae

et al. 2021

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Compartments of the crural fascia: clinically relevant ultrasound, anatomical and histological findings

Ortiz-Miguel,

Miguel-Pérez,

Blasi

et al. 2023

Surg Radiol Anat

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Purpose Compartment syndrome is a surgical emergency that can occur in any part of the body and can cause cell necrosis when maintained over time. The resulting defects can affect the nerves, muscle cells, bone tissue, and other connective tissues inside the compartment, and fasciotomy has to be performed. The anatomical and histological characteristics of the leg make acute, chronic, and exertional compartment syndrome more likely in this limb. For these reasons, knowledge of the ultrasound, anatomical, and histological features of the crural fascia can help in the treatment of leg compartment syndrome. Methods Twenty-one cryopreserved lower limbs from adult cadavers and from one 29-week-old fetus were obtained from the dissection room. They were examined by ultrasound and a subsequent anatomical dissection and microscopy to study the crural fascia and its relationship with the different muscles. Anthropometric measurements were taken of the distances from the head of the fibula and lateral malleolus to the origin of the tibialis anterior muscle in the crural fascia, the exit of the superficial fibular nerve, and the fascia covering the deep posterior muscles of the leg. Results The crural fascia has very important clinical relationships, which can be identified by ultrasound, as the origin of the tibialis anterior muscle at 16.25 cm from the head of the fibula and the exit of the superficial fibular nerve that crosses this fascia at 21.25 cm from the head of the fibula. Furthermore, the presence of a septum that fixes the deep posterior muscles of the leg and the vessels and nerve can be seen by ultrasound and can explain the possible development of a posterior compartmental syndrome of the leg. Awareness of these features will help to keep these structures safe during the surgical treatment of compartment syndrome. Conclusion The ultrasound study allows identification of anatomical structures in the leg and, thus, avoids damage to them during surgery for compartmental syndromes.

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